Definition
Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.
It primarily infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in both men and women.
It can also affect the mucous membranes of the mouth, throat, eyes, and rectum.
Etiology
Causative Agent: Neisseria gonorrhoeae, a gram-negative diplococcus bacterium.
Transmission: Spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. It can also be transmitted from mother to child during childbirth.
Pathogenesis
Attachment: N. gonorrhoeae attaches to epithelial cells of mucous membranes using pili (hair-like structures).
Invasion: The bacteria invade the epithelial cells and multiply.
Immune Evasion: N. gonorrhoeae produces proteins that inhibit immune responses and prevent destruction by neutrophils and macrophages.
Inflammation: The infection triggers an inflammatory response, leading to symptoms.
Signs and Symptoms
1) In Men
Urethritis: Inflammation of the urethra causing a burning sensation during urination.
Discharge: White, yellow, or green discharge from the penis.
Epididymitis: Painful swelling of the epididymis (a tube at the back of the testicles).
2) In Women
Cervicitis: Inflammation of the cervix causing vaginal discharge and bleeding between periods.
Urethritis: Burning sensation during urination.
Pelvic Pain: Pain in the lower abdomen, often associated with pelvic inflammatory disease (PID).
3) Rectal Gonorrhea
Discharge, anal itching, soreness, bleeding, and painful bowel movements.
4) Throat Gonorrhea (Pharyngeal Infection)
Sore throat, swollen lymph nodes, and sometimes fever.
5) Eye Infection (Conjunctivitis)
Redness, pain, and discharge from the eyes, more common in newborns.
Complications
Untreated Gonorrhea
In Men: Epididymitis, prostatitis, and infertility.
In Women: Pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and infertility.
Disseminated Gonococcal Infection (DGI): Bacteria spread through the bloodstream, causing arthritis, tenosynovitis, and dermatitis.
In Newborns: Ophthalmia neonatorum, a severe eye infection that can lead to blindness.
Diagnosis
NAAT (Nucleic Acid Amplification Test): The most sensitive test, used on urine samples or swabs from the affected area (urethra, cervix, rectum, or throat).
Culture: Bacterial culture from samples, useful for antibiotic sensitivity testing.
Gram Stain: Microscopic examination of stained discharge samples, particularly effective in men with symptomatic urethritis.
Treatment
Antibiotics
Dual Therapy: Typically involves a single intramuscular injection of ceftriaxone (500 mg) combined with oral azithromycin (1 g).
Alternatives: If ceftriaxone is unavailable, gentamicin plus azithromycin or doxycycline may be used.
Test-of-Cure: Follow-up testing to ensure the infection is fully eradicated, particularly in cases of persistent symptoms or known antibiotic resistance.
Partner Notification and Treatment
Sexual partners should be notified, tested, and treated to prevent reinfection and further spread of the disease.
Preventive Measures:
Safe Sex Practices: Consistent and correct use of condoms.
Regular Screening: Particularly for sexually active individuals with multiple partners or those in high-risk groups.
Education and Awareness: Informing people about the risks, symptoms, and prevention of gonorrhea.
Complications of Untreated Gonorrhea
Pelvic Inflammatory Disease (PID): In women, can cause chronic pain, ectopic pregnancy, and infertility.
Epididymitis: In men, leading to infertility.
Disseminated Gonococcal Infection (DGI): Can cause severe joint infections, endocarditis, and meningitis.
Newborn Complications: Severe eye infections leading to blindness.